Task
1
Letter
Report
and
Draft
Questionnaires
11/
24/
03
Form
#
5:
Activity
Time
Line
Technician:______________
Date:___________________
Participant
ID
No.:________
Data
Collection
Event#:
_____
Form
Approved
OMB
Control
No.
Approval
Expires
x/
x/
xx
Longitudinal
Study
of
Young
Children's
Exposures
in
their
Homes
to
Selected
Pesticides,
Phthalates,
Brominated
Flame
Retardants,
and
Perfluorinated
Chemicals
 
A
Children's
Environmental
Exposure
Research
Study
(
CHEERS)

Activity
Time
Line
(
Final
Draft
­
11/
24/
2003)

INTRODUCTION:

The
purpose
of
this
data
form
is
to
collect
the
information
on
the
participating
child's
activities
during
the
24­
hour
data
collection
period.
The
form
will
be
completed
by
the
adult
caregiver
of
the
child.
The
completed
form
will
be
collected
by
a
project
staff
at
the
end
of
the
24­
hour
data
collection
period.
The
Activity
Time
Line
(
ATL)
will
be
used
three
times
per
data
collection
event
(
first,
during
the
24­
hour
preapplication
sampling;
second,
on
the
application
day;
and
third,
during
post­
application
sampling).
The
ATL
will
be
prepared
in
a
booklet
format
for
each
24­
hour
period.
Since
the
start
time
for
each
participant
may
be
different
(
e.
g.,
some
at
9
a.
m.
and
some
at
2
p.
m.
or
5
p.
m.),
the
project
staff
will
prepare
the
ATL
booklet
for
each
participant
according
to
the
scheduled
start
time
for
each
data
collection
event.

Completion
of
this
questionnaire
is
completely
voluntary.

All
questionnaire
responses
are
confidential.

The
public
reporting
and
recordkeeping
burden
for
this
collection
of
information
is
estimated
to
average
1.4
hours
per
respondent
annually.
Burden
means
the
total
time,
effort,
or
financial
resources
expended
by
persons
to
generate,
maintain,
retain,
or
disclose
or
provide
information
to
or
for
a
Federal
agency.
This
includes
the
time
needed
to
review
instructions;
develop,
acquire,
install,
and
utilize
technology
and
systems
for
the
purposes
of
collecting,
validating,
and
verifying
information,
processing
and
maintaining
information,
and
disclosing
and
providing
information;
adjust
the
existing
ways
to
comply
with
any
previously
applicable
instructions
and
requirements;
train
personnel
to
be
able
to
respond
to
a
collection
of
information;
search
data
sources;
complete
and
review
the
collection
of
information;
and
transmit
or
otherwise
disclose
the
information.
An
agency
may
not
conduct
or
sponsor,
and
a
person
is
not
required
to
respond
to,
a
collection
of
information
unless
it
displays
a
currently
valid
OMB
control
number.
The
OMB
control
numbers
for
EPA's
regulations
are
listed
in
40
CFR
part
9
and
48
CFR
chapter
15.
To
comment
on
the
Agency's
need
for
this
information,
the
accuracy
of
the
provided
burden
estimates,
and
any
suggested
methods
for
minimizing
respondent
burden,
including
the
use
of
automated
collection
techniques,
EPA
has
established
a
public
docket
for
this
ICR
under
Docket
ID
No.
ORD­
2003­
0011,
which
is
available
for
public
viewing
at
the
Office
of
Environmental
Information
Docket
in
the
EPA
Docket
Center
(
EPA/
DC),
EPA
West,
Room
B102,
1301
Constitution
Ave.,
NW,
Washington,
DC.
The
EPA
Docket
Center
Public
Reading
Room
is
open
from
8:
30
a.
m.
to
4:
30
p.
m.,
Monday
through
Friday,
excluding
legal
holidays.
The
telephone
number
for
the
Reading
Room
is
(
202)
566­
1744,
and
the
telephone
number
for
the
Office
of
Environmental
Information
Docket
is
(
202)
566­
1752.
An
electronic
version
of
the
public
docket
is
available
through
EPA
Dockets
(
EDOCKET)
at
http://
www.
epa.
gov/
edocket.
Use
EDOCKET
to
submit
or
view
public
comments,
access
the
index
listing
of
the
contents
of
the
public
docket,
and
to
access
those
documents
in
the
public
docket
that
are
available
electronically.
Once
in
the
system,
select
"
search",
then
key
in
the
docket
ID
number
identified
above.
Also,
you
can
send
comments
to
the
Office
of
Information
and
Regulatory
Affairs,
Office
of
Management
and
Budget,
725
17th
Street,
NW,
Washington,
DC
20503,
Attention:
Desk
Office
for
EPA.
Please
include
the
EPA
Docket
ID
No.
(
ORD­
2003­
0011)
and
OMB
control
number
(
To
Be
Assigned)
in
any
correspondence.
Task
1
Letter
Report
and
Draft
Questionnaires
11/
24/
03
Form
#
5:
Activity
Time
Line
C:\
dmautop\
temp\
dwcgi­
7150­
1077835174­
63263000.
doc
2
Instructions
for
Completing
the
Activity
Time
Line
(
ATL)
Booklet
Thank
you
for
participating
in
the
CHEERS
study.
It
is
very
important
to
us
to
collect
activity
information
on
your
child
during
the
data
collection
period.

What
is
in
the
Activity
Time
Line
(
ATL)
booklet?

Please
review
this
activity
time
line
booklet.
It
is
prepared
for
your
participation
according
to
the
scheduled
appointment
time
with
you.
We
need
your
help
to
record
your
child's
activity
information
during
the
following
24­
hour
periods:

1.
The
day
before
your
planned
pesticide
application;
2.
The
day
you
(
or
someone)
apply
pesticide;
and
3.
The
day
after
pesticide
application.

You
will
notice
that
the
booklet
contains
a
number
of
pages
with
little
boxes
and
graphics.
Each
page
will
allow
you
to
record
your
child's
activities
up
to
4
hours.
These
pages
include:
Morning
12
 
4
AM,
Morning
4
 
8
AM,
Morning
8
 
12
NOON,
Afternoon
12
 
4
PM,
Afternoon
4
 
8
PM,
and
NIGHT
8
 
12
MIDNIGHT.

The
first
page
in
your
booklet
will
start
with
the
date
and
time
of
your
first
appointment
with
our
research
staff.
They
will
explain
this
booklet
and
give
you
some
examples
for
completing
this
booklet.

As
you
look
at
each
page,
you
will
notice
that
the
top
left
side
of
the
page
contains
the
following
information:
the
page
title
(
example:
Morning
12
 
4
AM),
the
PID
code
(
Participant
Identification
code)
which
is
a
number
assigned
to
each
participant,
Data
Collection
Event
number,
and
the
Date
of
recording
your
child's
activities.
On
the
top
right
side
of
the
page
are
four
pictures
representing
activities
such
as
sleeping,
eating,
quiet
play,
and
active
play
and
an
"
Activity
Number"
associated
with
each
of
these
activities.
The
remainder
of
the
page
is
divided
into
five
sections
that
include:

1.
Activity
Number
­
with
3
boxes
per
30
minute
interval
for
entering
information
on
the
child's
activities
during
the
time
period.
2.
Location
­
with
3
choices
for
marking
to
indicate
if
the
child
was
indoors,
outdoors,
or
away
from
home
during
the
30
minute
time
period.
3.
Room
­
with
5
choices
for
marking
to
indicate
the
room
or
rooms
that
the
child
was
in
during
the
30
minute
time
period.
4.
Parts
of
body
covered
­
with
5
choices
for
marking
to
indicate
the
parts
of
the
child's
body
that
was
covered
by
clothing
during
the
30
minute
time
period.
5.
Washing
­
includes
2
choices
for
marking
to
indicate
if
the
hands
and/
or
body
were
washed
during
the
30
minute
time
period.
Each
page
covers
a
four
hour
period
of
time.
Time
starts
on
the
first
page
with
midnight
and
runs
in
30
minute
increments.
For
example,
Morning
12
 
4
AM
page
is
midnight
to
4
am.
Task
1
Letter
Report
and
Draft
Questionnaires
11/
24/
03
Form
#
5:
Activity
Time
Line
C:\
dmautop\
temp\
dwcgi­
7150­
1077835174­
63263000.
doc
3
How
do
you
complete
the
activity
time
line?

The
PID,
Data
Collection
Event,
and
Date
will
be
completed
by
a
research
staff
before
you
are
given
the
booklet.
You
will
be
asked
to
complete
the
five
sections
as
described
below.

Activity
Number.
The
Activity
Number
section
has
3
boxes
for
each
30
minute
time
period.
For
each
30
minute
time
increment,
you
can
list
up
to
3
activities.
Write
only
one
number
in
each
box
selecting
from
the
activity
numbers
as
follows:
activity
number
1
is
sleeping,
activity
number
2
is
eating,
activity
number
3
is
quiet
play,
and
activity
number
4
is
active
play.
These
activities
and
activity
numbers
are
shown
for
reference
in
the
top
right
corner
of
each
page.
It
is
ok
if
your
child
is
doing
more
than
one
activity
in
each
time
period.

Location.
For
each
30
minute
time
period,
place
an
(
X)
or
check
mark
(

)
in
the
box
that
corresponds
to
the
location
(
Inside
Home,
Outside
Near
Home,
or
Away
From
Home)
where
your
child
has
been.
Please
be
sure
that
at
least
part
of
the
mark
is
inside
the
box.
More
than
one
box
can
be
marked.

Room.
For
each
30
minute
time
period,
place
an
(
X)
or
check
mark
(

)
in
the
box
that
corresponds
to
the
room
where
your
child
has
been.
There
are
5
empty
boxes
for
you
to
record
the
names
of
the
rooms.
Please
be
sure
that
at
least
part
of
the
mark
is
inside
the
box.
More
than
one
box
can
be
marked
if
your
child
stays
in
more
than
one
room
during
the
30
minutes
time
period.

Parts
of
the
Body
Covered.
The
Parts
of
Body
Covered
section
asks
you
about
the
type
of
clothing
that
your
child
is
wearing
during
each
30
minute
time
period.
For
example,
if
your
child
is
only
wearing
a
diaper,
then
you
would
place
an
(
X)
or
check
mark
(

)
in
the
box
for
the
bottom.
Another
example:
if
your
child
is
wearing
shorts
and
a
t­
shirt,
then
you
would
place
an
(
X)
or
a
check
mark
(

)
in
the
box
for
the
torso
and
bottom.
Please
be
sure
that
at
least
part
of
the
mark
is
inside
the
box.
More
than
one
box
can
be
marked.

Washing.
The
Washing
section
should
only
be
completed
if
you
have
bathed
your
child
during
the
30
minute
time
period
or
if
the
child's
hands
have
been
washed.
Note
the
hand
washing
times
if
your
child
washed
his/
her
hands
by
him/
herself
or
if
you
helped
him/
her
wash
his/
her
hands.
Please
place
an
X
or
check
mark
(

)
in
the
appropriate
boxes.
Please
be
sure
that
at
least
part
of
the
mark
is
inside
the
box.
More
than
one
box
can
be
marked
Remember,
for
each
30
minute
time
period,
there
can
be
multiple
boxes
checked
in
each
section.

QUICK
REFERENCE
Instructions
for
Completing
the
Activity
Time
Line
(
ATL)
Booklet
Task
1
Letter
Report
and
Draft
Questionnaires
11/
24/
03
Form
#
5:
Activity
Time
Line
C:\
dmautop\
temp\
dwcgi­
7150­
1077835174­
63263000.
doc
4
°
PID,
Data
Collection
Event,
and
Date
will
be
completed
by
the
research
staff
before
giving
the
booklet
to
the
Participant.

Please
print
clearly
and
mark
all
boxes
that
apply.
Place
only
one
number
or
mark
inside
each
box.
When
numbers
are
entered,
make
sure
the
number
is
clearly
written
inside
the
box.
When
check
marks
(

)
or
(
X)
are
used,
be
sure
that
at
least
part
of
the
mark
is
inside
the
box.

°
Activity
Number­
Enter
the
appropriate
"
activity
number"
(
1,
2,
3,
or
4)
in
each
box
for
up
to
three
activities
that
the
child
participated
in
during
the
listed
30
minute
time
interval.

°
Location
­
Mark
each
box
with
a
(

)
or
(
X)
to
indicate
the
location(
s)
of
the
child
during
the
listed
30
minute
time
interval.

°
Room
­
Mark
each
box
with
a
(

)
or
(
X)
to
indicate
the
rooms
inside
the
home
that
the
child
was
in
during
the
listed
30
minute
time
interval.
Please
fill
in
the
name
of
each
room.

°
Parts
of
Body
Covered
­
Mark
each
box
with
a
(

)
or
(
X)
to
indicate
the
parts
of
the
child's
body
that
was
covered
with
clothes
during
the
listed
30
minute
time
interval.

°
Washing
­
Mark
each
box
with
a
(

)
or
(
X)
to
indicate
if
the
child
was
bathed
or
if
hands
were
washed
during
the
listed
30
minute
time
interval.

Continue
for
each
30
minute
time
interval
for
the
entire
monitoring
period.
Please
call
our
toll­
free
number
(
1­
877­
810­
9530,
ext.
503)
if
you
have
questions
about
completing
the
ATL
booklet
or
about
any
other
study
activities.
Thanks
very
much
for
your
participation
in
this
study.
